EP3451295A1 - Anzeige der position und optischen achse eines endoskops in einem anatomischen bild - Google Patents

Anzeige der position und optischen achse eines endoskops in einem anatomischen bild Download PDF

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Publication number
EP3451295A1
EP3451295A1 EP18191681.8A EP18191681A EP3451295A1 EP 3451295 A1 EP3451295 A1 EP 3451295A1 EP 18191681 A EP18191681 A EP 18191681A EP 3451295 A1 EP3451295 A1 EP 3451295A1
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EP
European Patent Office
Prior art keywords
slice
medical tool
optical axis
organ
distal tip
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Pending
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EP18191681.8A
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English (en)
French (fr)
Inventor
Assaf Govari
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Biosense Webster Israel Ltd
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Biosense Webster Israel Ltd
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/12—Arrangements for detecting or locating foreign bodies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/46—Arrangements for interfacing with the operator or the patient
    • A61B6/461—Displaying means of special interest
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
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    • G06T11/00—2D [Two Dimensional] image generation
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    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T7/00—Image analysis
    • G06T7/10—Segmentation; Edge detection
    • G—PHYSICS
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    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/233—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the nose, i.e. nasoscopes, e.g. testing of patency of Eustachian tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B2090/364—Correlation of different images or relation of image positions in respect to the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/02—Arrangements for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
    • A61B6/03—Computed tomography [CT]
    • A61B6/032—Transmission computed tomography [CT]
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2200/00—Indexing scheme for image data processing or generation, in general
    • G06T2200/04—Indexing scheme for image data processing or generation, in general involving 3D image data
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    • G06T2207/20021—Dividing image into blocks, subimages or windows
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/30—Subject of image; Context of image processing
    • G06T2207/30004—Biomedical image processing

Definitions

  • the present invention relates generally to tracking a medical device in a patient organ, and particularly to methods and systems for navigating an endoscope in the organ without entering restricted sections thereof.
  • Some medical procedures require navigating a medical device between restricted sections of a patient organ.
  • U.S. Patent Application Publication 2014/0344742 describes system and method that include a processor, and memory coupled to the processor which stores a planning module.
  • a user interface is coupled to the processor and configured to permit a user to select a path through a pathway system.
  • the planning module is configured to upload one or more slices of an image volume corresponding to a user-controlled cursor point guided using the user interface, such that as the path is navigated, the one or more slices are updated in accordance with a depth of the cursor point in the path.
  • PCT Patent Application Publication WO 2015/149041 describes a system that includes a Q3D endoscope disposed to image a field of view and a processor that produces a Q3D model of a scene and identifies target instruments and structures.
  • the processor is configured to display the scene from a virtual field of view of an instrument, to determine a no fly zone around targets, to determine a predicted path for said instruments or to provide 3D tracking of said instruments.
  • An embodiment of the present invention that is described herein provides a method that includes receiving (i) a set of two-dimensional (2D) slices of a segmented three-dimensional (3D) anatomical image of an organ of a patient, and (ii) position signals that are indicative of respective position and orientation of a distal tip of a medical tool in the organ.
  • An optical axis of the medical tool is estimated based on the position signals.
  • a slice that is: (i) oriented at a predefined angle relative to the optical axis, and (ii) includes the position of the distal tip, is selected from among the slices. The selected slice is displayed to a user, together with a marker indicative of the position of the distal tip.
  • the predefined angle includes a right angle between the slice and the optical axis.
  • the method includes identifying one or more selected no-fly zone (NFZ) sections of the organ that are restricted for access of the medical tool, and displaying, in the slice, one or more respective markers indicative of respective sectional views of the one or more selected NFZ sections that fall in the slice.
  • displaying the marker includes providing a warning indication in response to detecting that at least part of the medical tool is within a predefined distance from at least one of the selected NFZ sections.
  • the organ includes a nasal sinus
  • receiving the set of slices of the segmented anatomical images includes receiving a set of slices of one or more computerized tomography (CT) segmented images of the nasal sinus.
  • receiving the position signals includes receiving the position signals from a position sensor of a position tracking system, the position sensor is coupled to a distal end of the medical tool.
  • the medical tool includes an endoscope.
  • estimating the optical axis includes estimating, based on a sequence of the position signals, a direction of movement of a distal end of the medical tool.
  • an apparatus that includes an interface and a processor.
  • the interface is configured to receive (i) a set of two-dimensional (2D) slices of a segmented three-dimensional (3D) anatomical image of an organ of a patient, and (ii) position signals that are indicative of respective position and orientation of a distal tip of a medical tool in the organ.
  • the processor is configured to estimate, based on the position signals, an optical axis of the medical tool, to select, from among the slices, a slice that is: (i) oriented at a predefined angle relative to the optical axis, and (ii) includes the position of the distal tip, and to display the selected slice to a user, together with a marker indicative of the position of the distal tip.
  • Some medical procedures may require navigating a medical device, such as an endoscope, in a patient head, without inserting the endoscope to restricted sections of the head, typically for patient safety reasons.
  • navigating a medical device such as an endoscope
  • Embodiments of the present invention that are described hereinbelow provide improved methods and systems for navigating an endoscope in the patient head without entering such restricted sections.
  • the navigation system receives a set of two-dimensional (2D) slices of a segmented three-dimensional (3D) anatomical image of the patient head, and position signals from a position sensor of a position tracking system.
  • the position signals are indicative of respective position and orientation of a distal tip of the endoscope in the patient head.
  • a processor in the navigation system is configured to estimate, based on the position signals, a direction of movement of the distal tip, which typically corresponds to an optical axis of the endoscope.
  • the processor is further configured to select, from among the 2D slices, a slice that (i) is orthogonal to the optical axis of the endoscope, and (ii) comprises the position of the distal tip.
  • the processor is configured to display the selected slice to a user, along with a marker indicative of the position of the distal tip.
  • a physician may select one or more sections in the patient head that are restricted for medical tools.
  • the processor is configured to store the selected sections in a memory and, when at least one of the restricted sections falls within the displayed slice, to display in the slice markers indicative of the restricted sections.
  • the processor is further configured to provide a warning indication to the physician, in response to detecting that the distal tip, or any other part of the endoscope, has been moved too close to one or more of the restricted sections, and therefore may cause damage to tissue therein.
  • the disclosed techniques are particularly important in minimally invasive medical procedures, such as in sinuplasty procedures, carried out in highly branched organs having restricted sections.
  • the disclosed techniques enable accurate navigation to a target location, and increase the patient safety by providing a warning indication that the endoscope may cause damage to tissue in the restricted sections.
  • Fig. 1 is a schematic pictorial illustration of a sinuplasty procedure using a sinuplasty system 20, in accordance with an embodiment of the present invention.
  • sinuplasty system 20 comprises a medical device, such as an ear-nose-throat (ENT) endoscope 28, which is configured to visualize an ENT section, e.g., a nasal sinus 37, of a patient 22.
  • ENT ear-nose-throat
  • the terms "tool” and “device” are used interchangeably and refer to any suitable medical devices used in a respective medical procedure.
  • endoscope 28 comprises a distal end 38 having a camera (shown in Fig. 2 below) coupled thereto, which a physician 24 inserts into a nose 26 of patient 22.
  • Endoscope 28 further comprises a handheld apparatus 30, coupled to a proximal end of distal end 38 and configured to assist physician 24 in navigating distal end 38 into sinus 37, so as to acquire images of sinus 37.
  • any suitable medical device (not shown), such as a cutter or a suction tool, may be coupled to endoscope 28.
  • system 20 further comprises a magnetic position tracking system, which is configured to track the position and orientation of one or more position sensors in the head of patient 22.
  • the magnetic position tracking system comprises magnetic field-generators 44 and a position sensor shown in Fig. 2 below.
  • the position sensor generates position signals in response to the sensed external magnetic fields from the field generators, thereby enabling a processor 34 to map the position and orientation of each sensor as will be described below.
  • This method of position sensing is implemented in various medical applications, for example, in the CARTOTM system, produced by Biosense Webster Inc. (Diamond Bar, Calif.) and is described in detail in U.S. Patents 5, 391, 199 , 6, 690, 963 , 6, 484, 118 , 6, 239, 724 , 6, 618, 612 and 6,332,089 , in PCT Patent Publication WO 96/05768 , and in U.S. Patent Application Publications 2002/0065455 A1 , 2003/0120150 A1 and 2004/0068178 A1 , whose disclosures are all incorporated herein by reference.
  • System 20 further comprises a location pad 40, which comprises field-generators 44 fixed on a frame 46.
  • pad 40 comprises five field-generators 44 but may comprise any other suitable number of generators 44.
  • Pad 40 further comprises a pillow (not shown) placed under a head 41 of patient 22, such that generators 44 are located at fixed, known positions external to patient 22.
  • system 20 comprises a console 33, which comprises a memory (not shown) and a processor 34, typically a general-purpose computer, with suitable front end and interface circuits for receiving signals from endoscope 28 having a magnetic sensor attached thereon (shown in Fig. 2 below), via a cable 32.
  • a console 33 which comprises a memory (not shown) and a processor 34, typically a general-purpose computer, with suitable front end and interface circuits for receiving signals from endoscope 28 having a magnetic sensor attached thereon (shown in Fig. 2 below), via a cable 32.
  • processor 34 is configured to map the position and orientation of the position sensor so as to estimate the position and orientation of a distal tip (shown in Fig. 2 below) of endoscope 28 in the coordinate system of the position tracking system.
  • processor 34 is configured to receive one or more anatomical images, such as computerized tomography (CT) images depicting respective segmented two-dimensional (2D) slices of a segmented three-dimensional (3D) anatomical image of a head 41 of a patient 22, obtained using an external CT system (not shown).
  • CT computerized tomography
  • the term “segmented” refers to displaying various types of tissue identified in each slice by measuring respective attenuation of the tissues in the CT system.
  • Console 33 further comprises input devices 39 and a user display 36, which is configured to display the data (e.g., images) received from processor 34 or inputs inserted by a user (e.g., physician 24).
  • data e.g., images
  • a user e.g., physician 24
  • processor 34 is configured to display from among the CT images, one or more selected 2D slices, such as an image 35, on user display 36.
  • image 35 is a segmented sectional view of nasal tissue of patient 22, such as sinus 37, which is typically orthogonal to the optical axis of endoscope 28.
  • processor 34 is configured to select, and display on display 36, any 2D slice at any predefined angle relative to the optical axis of endoscope 28.
  • the predefined angle can be constant or may change during the procedure and relative to the organ in question. It will be understood that in practice, the predefined angle may have some variations, for example, due to some latency in processor 34, or due to limited accuracy of the registration between the coordinate systems of the CT system and the position tracking system.
  • the segmented CT images are acquired before the sinuplasty procedure, such that physician 24 physician may mark selected sections on one or more of the segmented CT images.
  • the selected sections may be restricted for endoscope 28 or any other medical device.
  • processor 34 is further configured to display in image 35, markers indicating the selected sections, e.g., in sinus 37, which are restricted for endoscope 28.
  • these restricted sections are referred to and shown as "no-fly zone" (NFZ) 50.
  • NFZ no-fly zone
  • NFZ refers to a section in which the presence of any part of a medical device, such as distal tip 60 of endoscope 28, is not allowed.
  • Console 33 comprises a driver circuit (not shown), which is configured to drive field-generators 44 with suitable signals so as to generate magnetic fields in a predefined working volume around head 41.
  • Fig. 1 shows only elements related to the disclosed techniques, for the sake of simplicity and clarity.
  • System 20 typically comprises additional modules and elements that are not directly related to the disclosed techniques, and thus, intentionally omitted from Fig. 1 and from the corresponding description.
  • Processor 34 may be programmed in software to carry out the functions that are used by the system, and to store data in a memory (not shown) to be processed or otherwise used by the software.
  • the software may be downloaded to the processor in electronic form, over a network, for example, or it may be provided on non-transitory tangible media, such as optical, magnetic or electronic memory media.
  • some or all of the functions of processor 34 may be carried out by dedicated or programmable digital hardware components.
  • Fig. 2 is a schematic, pictorial illustration of distal end 38 of endoscope 28 and image 35, in accordance with an embodiment of the present invention.
  • a camera 54 which is configured to acquire images of sinus 37 and possibly of other nasal tissue of patient 22, is coupled to a distal tip 60 of endoscope 28.
  • a position sensor 54 is coupled to distal end 38 at a predefined location relative to distal tip 60.
  • position sensor 54 is configured to generate position signals in response to sensing external magnetic fields generated by field generators 44.
  • processor 34 is configured to register between coordinate systems of the CT system and the position tracking system, so as to map, based on the position signals provided by sensor 54, the position and orientation of distal tip 60 in the coordinate system of the CT system.
  • processor 34 is further configured to estimate, based on the position signals, a direction of movement of distal end 38, represented by an arrow 55, which direction typically corresponds to the optical axis of endoscope 28, represented by a dashed line 56.
  • processor 34 is configured to select, from among the 2D slices, a slice (e.g., image 35) in a plane 52 that is orthogonal to the optical axis (e.g., dashed line 56), wherein the selected site comprises the position of distal tip 60.
  • a slice e.g., image 35
  • the optical axis e.g., dashed line 56
  • processor 34 is configured to display a marker 61 that indicates the position of distal tip 60 in image 35. In some embodiments, processor 34 is further configured to display marker 61 in the center of image 35, so that physician 24 can see in segmented image 35, tissue located around distal tip 60.
  • processor 34 is configured to display any NFZ 50 that falls within image 35 during the movement of distal end 38.
  • processor 34 is configured to provide a warning indication to physician 24 in response to detecting that distal tip 60, or any other part of endoscope 28, has been moved too close to NFZ 50, and therefor may cause damage to tissue in NFZ 50.
  • the warning may be presented to physician 24 visually, as shown in image 35 of Fig. 2 .
  • the warning indication may comprise audio signals or in any other suitable type of alert.
  • processor 34 is configured to display, on the respective 2D slice, only distal tip 60 and its optical axis, as described above.
  • processor 34 is configured, at each location of distal tip 60, to select and display in real-time, a respective 2D slice that is orthogonal to the optical axis of endoscope 28 and that comprises the current location of distal tip 60 and one or more NFZs 50 that fall in the selected 2D slice.
  • processor 34 is configured to receive images acquired by camera 54 of endoscope 28, and for each such image, to select among the CT images, a 2D slice that best matches the image acquired by camera 54.
  • the position tracking system and sensor 58
  • the position tracking system may be omitted, or alternatively used as control means for verifying the location of the distal tip of endoscope 28. Note that these embodiments require setting specific parameters of camera 54, such as field of view and magnification.
  • Fig. 3 is a flow chart that schematically illustrates a method for visualizing position and orientation of distal tip 60 in image 35, in accordance with an embodiment of the present invention.
  • the method may comprise a preparation procedure carried out before performing the medical (e.g., sinuplasty) procedure, as well as operations carried out during the medical procedure.
  • the medical e.g., sinuplasty
  • the preparation procedure begins with processor 34 receiving from the CT system a set of 2D slices of anatomical images of the nasal tissue of patient 22, at an image acquisition step 100.
  • the 2D slices are segmented so as to identify various types of tissues in each slice.
  • processor 34 stores in the memory of console 33, sections of NFZs that were predefined by physician 24. Note that NFZ definition step 102 concludes the preparation procedure.
  • physician 24 inserts a medical device into nose 26 of patient 22.
  • the medical device comprises endoscope 28 and/or any other suitable device configured to carry out a diagnostic and/or treatment procedure in sinus 37 of patient 22.
  • endoscope 28 comprises position sensor 58 and camera 54 that are coupled to distal end 58 and distal tip 60, respectively.
  • processor 34 receives from sensor 58 position signals indicative of the position and orientation of distal tip 60 in sinus 37 of patient 22.
  • position sensor 58 is coupled to distal end 38 at a predefined offset relative to distal tip 60, in which case processor 34 is configured to estimate, based on the position signals and the predefined offset, the position and orientation of distal tip 60 in sinus 37 or in any other organ of patient 22.
  • processor 34 receives a sequence of position signals from sensor 58 corresponding to locations of distal end 38 as physician 24 moves endoscope 28 in head 41 of patient 22. Based on the sequence of the position signals, processor 34 estimates the direction of movement of distal end 38, represented by an arrow 55 in Fig. 2 above, which typically corresponds to the optical axis of endoscope 28.
  • processor 34 selects from among the 2D slices, a slice that is orthogonal to the optical axis of endoscope 28 and that comprises the position of distal tip 60, typically at the center of the slice. In some embodiments, processor 34 displays the 2D slice, e.g., as segmented image 35, on display 36.
  • processor 34 displays in image 35 a marker indicative of the position and optical axis of distal tip 60, such that physician 24 can see a segmented sectional view of distal tip 60 in the organ in question (e.g., sinus 37.)

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EP18191681.8A 2017-08-31 2018-08-30 Anzeige der position und optischen achse eines endoskops in einem anatomischen bild Pending EP3451295A1 (de)

Applications Claiming Priority (1)

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US15/693,271 US10506991B2 (en) 2017-08-31 2017-08-31 Displaying position and optical axis of an endoscope in an anatomical image

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US (1) US10506991B2 (de)
EP (1) EP3451295A1 (de)
JP (1) JP7350470B2 (de)
CN (1) CN109419556A (de)
AU (1) AU2018220039A1 (de)
CA (1) CA3015770A1 (de)
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